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Zhang X, Xu T, Qin Y, Wang M, Li Z, Song J, Tang Q, Wang Z, Xu L, Wu L, Yue P. Exploring the needs and coping strategies of family caregivers taking care of dying patients at home: a field study. BMC Palliat Care 2023; 22:196. [PMID: 38087244 PMCID: PMC10714660 DOI: 10.1186/s12904-023-01315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Most Chinese patients chose to die at home, therefore there is a reliance on the family caregivers to be involved in their palliative care. The needs and coping strategies of family caregivers in home-based palliative care are rooted in culture. Little is known about the needs and coping strategies of family caregivers taking care of dying patients at home. METHODS A field study using semi-structured interview, participant observation, documents and records collection was employed. The study was conducted in two palliative care outpatient departments in tertiary hospitals and four communities in Beijing, China from March 2021 to July 2022. Using purposive sampling, twenty-five family caregivers were recruited. All collected data were analyzed using content analysis approach. RESULTS Five themes emerged, including three care needs and two coping strategies. Family caregivers need to learn care skills and acquire care resources, including (i) decision-making about home-based palliative care, (ii) improving patient's quality of life, and (iii) signs of final hours and funeral procedures. In facing the care burden, family caregivers coped by (iv) balancing the roles of caregivers and individuals: giving priority to patient care while maintaining their own normal life. In facing the death of a loved one, family caregivers responded by (v) making room for coming death by facing death indirectly and "rescuing" patients for consolation while preparing for the coming death. CONCLUSION Family caregivers strive to balance the roles of being caregivers and being themselves. As caregivers, they actively prepare patients for good death with no regrets. As individuals, they preserve themselves from being hurt to maintain normal life. The needs of family caregivers focus on caregiver role and are manifested in care skills and resources. TRIAL REGISTRATION Not registered.
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Affiliation(s)
- Xiaotian Zhang
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Tianmeng Xu
- Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, 325035, China
| | - Yuan Qin
- Hospice & Palliative Care Department Ward of Beijing Haidian Hospital, Beijing, 100080, China
| | - Minghui Wang
- Puhuangyu community health center, Fengtai District, Beijing, 100079, China
| | - Zhaoyu Li
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Jingyu Song
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Qianqian Tang
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Zidan Wang
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Lijie Xu
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China
| | - Lingling Wu
- Puhuangyu community health center, Fengtai District, Beijing, 100079, China
| | - Peng Yue
- School of Nursing, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China.
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Taking care of who cares: Evaluation of a training program for home palliative care professionals. Palliat Support Care 2023:1-5. [PMID: 36852885 DOI: 10.1017/s1478951523000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVES To evaluate an enrichment training program targeted at home palliative care professionals in terms of its effects and participants' satisfaction. The program had 2 main aims: give voice to professionals' emotional fatigue and promote their personal resources. METHODS One hundred twenty-three home palliative care professionals participated in 12 parallel training courses; each course consisted of four 3-hour meetings led by 2 trainers and involved about 10-15 participants. The program adopted the method and tools typical of the enrichment approach, with the insertion of an art therapy exercise in the central meetings. The topics addressed were the following: emotional awareness in care relationship; the recognition of the needs of the patient, the family, and the professional himself; the inevitability of the death of the patient; and the challenges and resources of the multidisciplinary care team. At the first (T1) and last (T2) meetings, participants filled in a self-report questionnaire assessing work emotional fatigue, empowerment, generativity, and satisfaction with the course. RESULTS Participants were highly satisfied with the course. They reported a higher level of work emotional fatigue and a higher perception of personal resources, in terms of empowerment (both individual-oriented and relationship-oriented) and generativity at the end of the program than before. SIGNIFICANCE OF RESULTS Results confirm the need to provide home palliative care professionals with trainings in which they can express, share, and deal with personal and professional needs. This course gave voice to professionals' work emotional fatigue and promoted their personal resources, while enhancing collaboration in the multidisciplinary team.
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Canzona MR, Love D, Barrett R, Henley J, Bridges S, Koontz A, Nelson S. Piloting an Interprofessional Narrative-Based Interactive Workshop for End-of-Life Conversations: Implications for Learning and Practice. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:862-888. [PMID: 33557720 DOI: 10.1177/0030222821993633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Based on the principles of Narrative Medicine, this study explored a narrative-based workshop for multi-level interdisciplinary clinicians who have EOL conversations. METHODS Fifty-two clinicians participated in narrative-based interactive workshops. Participants engaged narrative in three forms: viewing narratives, writing/sharing narratives, and co-constructing narratives. Post workshop interviews were conducted and thematically analyzed. RESULTS Five themes characterized how the workshop shaped learning and subsequent care experiences: (1) learning to enter/respond to the patient stories, (2) communicating across professions and disciplines, (3) practicing self-care. Additional themes emphasized (4) barriers to narrative learning and (5) obstacles to applying narrative to practice. DISCUSSION Results highlight the function/utility of narrative forms such as the value of processing emotions via reflective writing, feeling vulnerable while sharing narratives, and appreciating colleagues' obstacles while observing patient-clinician simulations. Challenges associated with narrative such as writing anxiety and barriers to implementation such as time constraints are detailed to inform future initiatives.
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Affiliation(s)
- Mollie Rose Canzona
- Department of Communication, Wake Forest University, Winston-Salem, North Carolina, United States.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Deborah Love
- Department of Social Medicine, UNC-Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States.,Novant Health, Winston-Salem, North Carolina, United States
| | - Rolland Barrett
- Forsyth Medical Center, Novant Health, Winston-Salem, North Carolina, United States
| | - Joanne Henley
- Novant Health, Winston-Salem, North Carolina, United States
| | - Sara Bridges
- Novant Health, Winston-Salem, North Carolina, United States
| | - Adam Koontz
- Novant Health, Winston-Salem, North Carolina, United States
| | - Sharon Nelson
- Novant Health, Winston-Salem, North Carolina, United States
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Care partner support. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:203-219. [PMID: 36599509 DOI: 10.1016/b978-0-12-824535-4.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Palliative care focuses on improving the quality of life of people living with serious illness and their family carers. However despite policy, clinical, and research evidence underpinning the importance of a family approach to care, as well as justification for early palliative care integration, systemic inadequacies have impeded the quality of family support. This chapter provides an overview of common concepts in caregiving, a framework through which carer well-being can be understood, and an overview of disease specific considerations for care partners. There are several main needs that are relevant to care partners across disease settings include (1) information and guidance to prepare them for the role; (2) how to alleviate discomfort for the person with illness; (3) enhancing skills for the physical tasks of the role; (4) strategies for managing the psychological, and financial implications of the care partner role; and (5) assistance in advance care planning and on preparing for the care recipient's death. Care partner coping is a result of complex interactions between stressors and mediators as they navigate chronic illness, but palliative providers with an understanding of these factors are well-positioned to address carer risk factors and provide appropriate support.
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Rosa WE, Cannity K, Moreno A, Cardillo C, Schofield EA, Korc-Grodzicki B, Parker PA, Manna R, Alici Y, Nelson C, Alexander K, Banerjee SC. Geriatrics communication skills training program for oncology healthcare providers to improve the management of care for older adults with cancer. PEC INNOVATION 2022; 1:100066. [PMID: 36741338 PMCID: PMC9894477 DOI: 10.1016/j.pecinn.2022.100066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective We evaluated the feasibility, acceptability, and preliminary efficacy of a novel intervention, the Geriatric Communication Skills Training Program (Geriatric Comskil Training) for multidisciplinary healthcare providers (HCPs). Methods Three 2-h modules comprised the training: Geriatrics 101, Cognitive Syndromes, and Shared Decision-Making. Modules consisted of didactic knowledge, exemplary videos, and experiential learning role plays with standardized patients. We collected pre- and post-training data from 11 HCPs (module evaluations, self-efficacy, communication skills uptake in interaction with standardized patients, perceived ageism) and 44 patients (perceived HCP empathy, satisfaction with HCP communication). Results HCPs rated all modules high, with over 90% agreement on all course evaluation items assessing involvement, critical thinking, and reflectiveness, and significant improvements in self-efficacy. HCPs demonstrated an uptake in communication skills from pre- to post-training in agenda setting and overall skill use and reported promising trends towards lower ageism scores (d = 0.58). Promising trends in patient-reported HCP empathy (d = 0.39) and satisfaction with communication (d = 0.29) emerged from pre- to post-training. Conclusion Continued efforts are needed to strengthen HCP education related to geriatric communication across the cancer continuum. Innovation The Geriatric Comskil Training demonstrated feasibility, acceptability, and increases in self-efficacy and communication skills uptake for HCPs.
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Affiliation(s)
| | | | - Aimee Moreno
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cara Cardillo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Ruth Manna
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Smita C. Banerjee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA,Corresponding author at: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022, USA., (S.C. Banerjee)
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What does it mean to be the main caregiver to a terminally ill family member in Lithuania?: A qualitative study. PLoS One 2022; 17:e0265165. [PMID: 35551302 PMCID: PMC9098011 DOI: 10.1371/journal.pone.0265165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/25/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Family caregivers are a great resource for providing dignified end-of-life care for terminally ill patients. Framed from the perspective of role theory and the relational nature of providing and receiving care, study objectives were as follows: (1) to capture caregivers’ understanding of the process of taking on the role of main caregiver, (2) to conceptualize their understanding of the functions that they assume while being the main caregivers, and (3) to understand how they experienced the consequences they confronted.
Methods
The research team employed the methodological strategy of descriptive thematic analysis using a semi-structured interview guide. The sample consisting of 33 family caregivers was recruited using purposeful and snowball sampling strategies in 2020. Interview data was analyzed using content-driven inductive thematic analysis.
Results
The data analysis revealed four main themes that structure the process of becoming the main care giver of a terminally ill family member and the meaning of the caregiver role: (1) inaccessibility and mistrust of public care services for persons with terminal illness, (2) moral obligations and responsibilities of immediate family and friends, (3) cultural traditions, (4) the caregiver feels responsible for everything. The themes describe the social role of family caregiver in social context, address the process of taking on the role of caregiver and living with systemic corruption.
Conclusions
Recognition of caregiving experiences is essential in planning better systems, in direct practice and in confronting corruption. The study suggests the need for open communication, accessibility of quality services, and the recognition of caregivers as care-team members. The larger implication is that the increasing numbers of distressed caregivers and aging populations can be considered as public health populations, and thus addressable through public health methods.
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Factors associated with psychological distress in caregivers of patients with malignant gliomas. Support Care Cancer 2022; 30:5811-5820. [DOI: 10.1007/s00520-022-06989-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Cheng HL, Leung DYP, Ko PS, Chung MW, Lam WM, Lam PT, Luk AL, Lam SC. Reliability, validity and acceptability of the traditional Chinese version of the carer support needs assessment tool in Hong Kong palliative care settings. BMC Palliat Care 2021; 20:152. [PMID: 34627225 PMCID: PMC8502334 DOI: 10.1186/s12904-021-00852-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Among the few existing needs assessment tools for family carers, the 14-item Carer Support Needs Assessment Tool (CSNAT) is the only brief and holistic needs screening tool designed for everyday use in palliative care practices. The aim of this study was to evaluate the reliability, validity, and acceptability of the traditional Chinese version of the CSNAT in palliative care settings in Hong Kong. Methods This adopted a cross-sectional and correlation design with repeated measures. The participants were 125 family carers of palliative cancer patients and 10 healthcare providers (HCPs) that were recruited from two local hospitals. The evaluation of psychometric properties included the following: (1) content validity through HCPs including frontline physicians, nurses, social workers, and clinical psychologists; (2) construct validity between the CSNAT items and those of the validated tools that measured caregiver burden, social support, and caregiving self-efficacy; and (3) one-week test-retest reliability in a sub-sample of 81 caregivers. The acceptability of the tool was assessed by the carers using several closed-ended questions. Results The content validity index of the CSNAT at the scale level was 0.98. Each item of the CSNAT was significantly and moderately correlated with caregiver burden (Spearman’s r = 0.24 to 0.50) and caregiving self-efficacy (r = − 0.21 to − 0.52), but not for social support. All CSNAT items had fair to moderate test-retest reliability (weighted kappa = 0.21 to 0.48), with the exception of two items “managing your relatives’ symptoms, including giving medicines” and “having time for yourself in the day”. Regarding the acceptability of the CSNAT, almost all HCPs were willing to use the CSNAT for carer assessment and support. 89.6% of the carers demonstrated a comprehensibility of the CSNAT tool and 92.9% felt comfortable answering the questions. Around 90% of the carers agreed to use the tool for screening, discussing needs, and making referrals. Conclusion The traditional Chinese version of the CSNAT is a tool with high validity and acceptability and adequate reliability that measures family carers’ support needs, which should be considered for wide application in local palliative care practices.
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Affiliation(s)
- Hui-Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hom Hung, Kowloon, Hong Kong SAR, China.
| | - Doris Yin Ping Leung
- School of Nursing, The Hong Kong Polytechnic University, Hom Hung, Kowloon, Hong Kong SAR, China
| | - Po Shan Ko
- Nursing Services Division, United Christian Hospital, Hong Kong SAR, China
| | - Ming Wai Chung
- School of Nursing, The Hong Kong Polytechnic University, Hom Hung, Kowloon, Hong Kong SAR, China
| | - Wai Man Lam
- Department of Medicine, Haven of Hope Hospital, Hong Kong SAR, China
| | - Po Tin Lam
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Andrew Leung Luk
- Nethersole Institute of Continuing Holistic Health Education, Hong Kong SAR, China
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Kremeike K, Dojan T, Rosendahl C, Jünger S, Romotzky V, Boström K, Frerich G, Voltz R. "Withstanding ambivalence is of particular importance"-Controversies among experts on dealing with desire to die in palliative care. PLoS One 2021; 16:e0257382. [PMID: 34559828 PMCID: PMC8462710 DOI: 10.1371/journal.pone.0257382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
In order to investigate controversies surrounding the desire to die phenomenon in palliative care by analyzing expert opinions on the topic, we carried out a secondary qualitative data analysis of free text comments collected during a Delphi survey that was designed to develop a conversation aid for dealing with desire to die in everyday clinical practice. Between 01/2018 and 03/2018, a two-round Delphi survey was carried out with national (German) and international palliative care experts. Free text comments were reinvestigated to identify controversies surrounding the desire to die phenomenon. An additional in-depth analysis focused on statements expressing attitudes towards proactively addressing (potential) desires to die. Within the Delphi survey, 103 of 149 multi-professional participants (almost all of them with practical and only six with exclusively theoretical expertise in palliative care) generated 444 free text comments. Thereof, we identified three main categories related to dealing with desire to die: "outer framework", "extended care system" and "health-professional-patient-relationship". Ambivalences, taboos and uncertainties surrounding desire to die in palliative care became apparent. Experts are divided concerning the practice of proactively addressing desire to die. Even if these conversations-especially the proactive approach-are also viewed critically, we conclude that open-ended and respectful communication about desire to die between health professionals and patients can be understood as an eligible intervention in palliative care. Proactively addressing the topic is a possible way to open up such conversations.
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Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Carolin Rosendahl
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Department of Community Health, University of Applied Health Sciences, Bochum, Germany
| | - Vanessa Romotzky
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kathleen Boström
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Gerrit Frerich
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Cologne / Bonn (CIO), University of Cologne, Cologne, Germany
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
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Hussain FA. Psychological challenges for nurses working in palliative care and recommendations for self-care. ACTA ACUST UNITED AC 2021; 30:484-489. [PMID: 33876679 DOI: 10.12968/bjon.2021.30.8.484] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Working in palliative care services has an impact on the personal and professional lives of healthcare staff. The complex practicalities of the role and additional factors such as moral distress, burnout, compassion fatigue and death anxiety all impact on the overall quality of services and patient care. This article aims to highlight what is known of the practical and emotional challenges for palliative nursing care and offers recommendations to services to support staff at an organisational as well as individual level, to help create a more supportive workplace for staff and patients alike. It follows previous research on working in palliative and end-of-life care.
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Affiliation(s)
- Feryad A Hussain
- Clinical Psychologist, Cancer and End-of-Life Services, Black Country Partnership NHS Foundation Trust
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The validity and reliability of the Turkish version of the Family Inventory of Needs. Palliat Support Care 2021; 20:255-263. [PMID: 34158143 DOI: 10.1017/s1478951521000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this methodological study was to test the validity and reliability of the Turkish version of the Family Inventory of Needs. METHODS The universe of the study consisted of 300 family members of inpatients hospitalized in the palliative care units of four hospitals in northern Turkey between April 12, 2019 and December 30, 2019. The translation process was performed in multiple stages using the forward-backward translation model. The reliability of the Family Inventory of Needs was evaluated using the Cronbach α reliability coefficient and item-total score correlations. Exploratory factor analyses were applied to examine the factor structure of the scale and its construct validity. To test the time invariance of the scale, the relationships between the scores obtained from the first and second applications were examined using the intraclass correlation coefficient (ICC). RESULTS The Kaiser-Meyer-Olkin value of the Family Inventory of Needs was found to be 0.893. The items of the Family Inventory of Needs were found to explain 45.23% of the total variance in scores. The Turkish form of the scale consisted of the importance and fulfillment subdimensions, and had 19 items. The ICCs of the test-retest scores of the importance and fulfillment subdimensions of the Family Inventory of Needs were found to be, respectively, ICC = 1.000 and ICC = 0.730 with a positive, linear, and highly significant relationship between the scores. The item-total score correlation coefficients of the scale were found to vary between 0.920 and 0.908 in the importance subdimension, and between 0.930 and 0.922 in the fulfillment subdimension. SIGNIFICANCE OF RESULTS The Turkish version of the Family Inventory of Needs was found to be a valid and reliable measurement tool that can be safely used with the family members of Turkish inpatients.
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Melis P, Galletta M, Aviles Gonzalez CI, Contu P, Jimenez Herrera MF. Experiencing communication related to knowing the cancer diagnosis and prognosis: A multi-perspective interpretative phenomenological study. Eur J Oncol Nurs 2021; 51:101904. [PMID: 33578333 DOI: 10.1016/j.ejon.2021.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/12/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To understand the phenomenon of communication related to knowing the diagnosis and prognosis, by exploring the perspectives of patients with advanced cancer and those of their caregivers, physicians and nurses. METHODS Drawing upon a multi-perspective design, a total of 27 semi-structured interviews involving four different groups of stakeholders (7 patients, 7 caregivers, 6 physicians, and 7 nurses) -who were linked by a carer-cared relationship-were conducted in two Oncology Departments of two Italian hospitals. Interpretative Phenomenological Analysis was used to interpret the participants' narratives. RESULTS Two overarching themes were identified: The first theme "the «what is it?» and the «what will happen to me?»" illustrates the two different paths of communication of diagnosis and prognosis. The second theme "Matching and mismatching in identifying the others as speakers" shows that not each of the four parties recognizes the others as reciprocal speakers on topics related to diagnosis and prognosis, although all of them display reciprocal communication interactions. CONCLUSIONS Communication related to diagnosis and prognosis is often handled by health professionals without a comprehensive and integrated understanding of the communication approach. There is a correspondence between the nurses' perception of their extraneousness to the diagnosis and the prognosis related communication, and the descriptions and perceptions of the nurse's role reported by the other participants. Understanding how the different groups of stakeholders reciprocally interact and influence each other, can help to identify potential positive resources and detect hindrance in the implementation of an effective patient-centered approach, while avoiding silo cultures.
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Affiliation(s)
- Paola Melis
- Departament d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maura Galletta
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | | | - Paolo Contu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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McGraw C, Vogel R, Redmond D, Pekarek J, Tanner A, Lynch N, Bar-Or D. Comparing satisfaction of trauma patients 55 years or older to their caregivers during palliative care: Who faces the burden? J Trauma Acute Care Surg 2021; 90:305-312. [PMID: 33075029 DOI: 10.1097/ta.0000000000002983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Many studies report on the patient-caregiver relationship during palliative care (PC); however, this relationship has yet to be examined following traumatic injury. METHODS This prospective cohort study included trauma patients (≥55 years) and their primary caregivers admitted at two level I trauma centers for 2 years (November 2016 to November 2018), who received PC and who completed satisfaction surveys before discharge; surveys were analyzed by four domains: information giving, availability of care, physical care, and psychosocial care, and by PC assessments: consultations, prognostications, formal family meetings (FFMs), and advanced goals of care discussions. The primary outcome was the percentage of patients and caregivers who were satisfied (defined as ≥80%) and was analyzed using McNemar's test. Adjusted mixed models identified PC assessments that were associated with satisfaction scores ≥80% for patients and caregivers. RESULTS Of the 441-patient and 441-caregiver pairs, caregivers were significantly less satisfied than patients during prognostications (information giving, physical care), FFMs (information giving, physical care), and consultations (physical care), while caregivers were significantly more satisfied than patients during advanced goals of care discussions (availability of care, psychosocial care). After adjustment, significant predictors of caregiver satisfaction (≥80%) included longer patient hospital length of stay (>4 days), caring for a male patient (physical care, availability of care), higher caregiver age (≥55 years; availability of care), and higher patient age (≥65 years; psychosocial care). Conversely, all PC assessments decreased odds of satisfaction for caregivers in every domain except physical care. Significant predictors of higher patient satisfaction included FFMs (for every domain) and PC consultations (psychosocial care), and decreased odds included advanced goals of care discussions and prognostication assessments (information giving, psychosocial care). CONCLUSIONS Palliative care increased satisfaction of patients, especially family meetings and consultations, while assessments were predictive of lower caregiver satisfaction, suggesting that caregivers may be experiencing some of the patient burden. LEVEL OF EVIDENCE Therapeutic/Care Management, level IV.
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Affiliation(s)
- Constance McGraw
- From the Trauma Research Department (C.M., J.P., D.B.-O.) and Trauma Services Department (R.V.), St. Anthony Hospital, Lakewood; Trauma Research Department (C.M., D.R., D.B.-O.) and Trauma Services Department (A.T., N.L.), Penrose-St. Francis Hospital, Colorado Springs, Colorado
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Kurkowski S, Radon J, Vogt AR, Weber M, Stiel S, Ostgathe C, Heckel M. Hospital end-of-life care: families' free-text notes. BMJ Support Palliat Care 2020:bmjspcare-2020-00239. [PMID: 33243824 DOI: 10.1136/bmjspcare-2020-00239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/27/2020] [Accepted: 11/14/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Palliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients' loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones' perspectives on need for improvements. AIM To identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire. DESIGN Within the validation study of the questionnaire 'Care of the Dying Evaluation' (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring. SETTING/PARTICIPANTS Loved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017. RESULTS 993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient's and/or loved one's will, involvement in decision-making at the end of life (patient's volition) and having the possibility to say goodbye. CONCLUSIONS It is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients' will and to be emotionally supported. TRIAL REGISTRATION NUMBER This study was registered at the German Clinical Trials Register (DRKS00013916).
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Affiliation(s)
- Sandra Kurkowski
- Department of Palliative Medicine, Friedrich Alexander University Erlangen Nuremberg Faculty of Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Radon
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Annika R Vogt
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Friedrich Alexander University Erlangen Nuremberg Faculty of Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, Friedrich Alexander University Erlangen Nuremberg Faculty of Medicine, University Hospital Erlangen, Erlangen, Germany
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15
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Gregory C, Gellis Z. Problem Solving Therapy for Home-Hospice Caregivers: A Pilot Study. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:297-312. [PMID: 32865148 DOI: 10.1080/15524256.2020.1800554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This pilot study examined the effects of Brief Problem-Solving Therapy on caregiver quality of life, depression, and problem-solving in family caregivers of hospice patients. Thirty-seven family caregivers to home-based hospice patients (mean age 62.8 [SD = 12.32]) were randomized to the study group (PST-Hospice), for a 45 minute per week/5 week intervention or comparison group of usual care plus caregiver education (UC + CE). The severity of depressive symptoms, caregiver quality of life and problem-solving functioning were assessed at baseline and follow-up. At post-test, the PST-Hospice condition had significantly higher scores on caregiver quality of life compared to UC + CE. On the Social Problem Solving Inventory-Revised Short Form (SPSI-R) measure, PST-Hospice scores clinically improved as compared to UC + CE on Positive Problem Orientation and Rational Problem-Solving subscales. In addition, this pilot study found that brief problem-solving treatment delivered by a hospice social worker appears to be an acceptable and feasible tool for routine use in the home-hospice setting.
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Affiliation(s)
- Christin Gregory
- Center for Mental Health and Aging, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zvi Gellis
- Center for Mental Health and Aging, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Arias-Rojas M, Carreño-Moreno S, Rojas-Reyes J. Uncertainty Towards the Disease of Family Caregivers of Patients in Palliative Care: A Scoping Review. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.3.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To know the development of the scientific evidence on the uncertainty towards the disease of family caregivers of patients in palliative care.
Materials and methods: A descriptive scoping review. A search was conducted in the Embase, ScienceDirect, Medline, Academic Search Complete, Scopus databases, during the 2000-2019 period. The following MeSH terms were used: uncertainty, palliative care, end of life, nursing and caregiver. Fifty articles were selected after the criticism process.
Results: Five thematic nuclei emerged: characterization of uncertainty in the caregiver, factors influencing uncertainty, resources to manage uncertainty, uncertainty assessment, and therapies and interventions to approach uncertainty. The higher scale of evidence is found in the characterization of uncertainty in the caregiver, and the voids direct the development of Nursing interventions on the uncertainty of the caregivers of individuals in palliative care.
Conclusions: Although the factors influencing uncertainty towards the disease of the caregiver are widely explored, the evidence on the interventions that may help to reduce uncertainty towards the disease is still limited.
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17
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Scherrens AL, Beernaert K, Magerat L, Deliens L, Deforche B, Cohen J. Palliative care utilisation: family carers' behaviours and determinants-a qualitative interview study. BMJ Support Palliat Care 2020; 12:e146-e154. [PMID: 32868284 DOI: 10.1136/bmjspcare-2020-002207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/16/2020] [Accepted: 07/12/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Most research on starting palliative care focuses on the role of healthcare services and professional carers. However, patients and their family carers may also play a role. Especially opportunities for starting palliative care might exist among family carers. This study focused on family carers by identifying their behaviours and underlying determinants that might contribute to starting palliative care. METHODS A qualitative study with 16 family carers of deceased persons who used palliative care was conducted using semistructured, face-to-face interviews. Constant comparison analysis was used to identify groups of behaviours that influenced starting palliative care and related determinants. The behavioural determinants were matched with concepts in existing behavioural theories. A preliminary behavioural model was developed. RESULTS Most reported behaviours regarding starting palliative care were related to communicating with the seriously ill person, other family members and professional carers; seeking information and helping the seriously ill person process information from professional carers; and organising and coordinating care. Determinants facilitating and hindering these behaviours included awareness (eg, of poor health), knowledge (eg, concerning palliative care), attitudes (eg, negative connotations of palliative care) and social influences (eg, important others' opinions about palliative care). CONCLUSIONS This study identified relevant family carers' behaviours and related determinants that can contribute to starting palliative care. As these determinants are changeable, the palliative care behavioural model that resulted from this study can serve as a basis for the development of behavioural interventions aiming at supporting family carers in performing behaviours that might contribute to starting palliative care.
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Affiliation(s)
- Anne-Lore Scherrens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium .,Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.,Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Laurence Magerat
- Occupational Therapy, Artesis Plantijn Hogeschool Antwerpen, Antwerpen, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.,Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Benedicte Deforche
- Public Health and Primary Care, Ghent University, Ghent, Belgium.,Movement and Sport Sciences, Physical activity, Nutrition and Health Research unit, Vrije Universiteit Brussel, Brussels, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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18
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Vigna PM, de Castro I, Fumis RRL. Spirituality alleviates the burden on family members caring for patients receiving palliative care exclusively. BMC Palliat Care 2020; 19:77. [PMID: 32493301 PMCID: PMC7271458 DOI: 10.1186/s12904-020-00585-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background Spirituality can give meaning to life, providing support and guidance in complex situations. Despite its importance in palliative care, the role of spirituality for family caregivers of patients under exclusive palliative care has not received enough attention in the literature. We aimed to address the correlation between spirituality and the emotional burden of family members of patients under exclusive palliative care. Methods This transversal study was conducted in a tertiary private teaching hospital, in São Paulo, Brazil. The study comprised family members of patients receiving palliative care exclusively. Only one caregiver who cared for the patient for at least 2 months was invited to participate. Family members answered the following questionnaires: WHOQOL spirituality, religiousness and personal beliefs (SRPB), Zarit Burden Interview (ZBI) and Self-Reporting Questionnaire (SRQ-20). They were excluded if patients were residing in a Long Stay Institution. Continuous variables were expressed by median and quartiles and analyzed with the Kruskal-Wallis test with Muller-Dunn post-test adjusted by Bonferroni or with the Mann-Whitney test for two groups. We used multivariable linear regression to identify independent predictors of caregiver burden. Results A total of 178 family members were interviewed in a median of 8 [4–13.25] days after patient admission. Almost 40% of families presented high score of burden. Faith and Meaning in Life were the facets that scored the highest, with a median of 4.50 [4.00–5.00] for both facets. There was an inverse correlation between Zarit score and all of the WHOQOL-SRPB facets, indicating that the lower the spirituality, the greater the emotional burden. Inner peace was the strongest protective factor associated with burden. Conclusions Psycho-socio-spiritual interaction can improve the coping ability of family caregivers of patients under exclusive palliative care, addressing a critical gap in the provision of holistic palliative care services.
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Affiliation(s)
| | - Isac de Castro
- Division of Nephrology and Molecular Medicine, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Renata Rego Lins Fumis
- Intensive Care Unit, Hospital Sírio-Libanês - São Paulo, Rua Dona Adma Jafet, 115 - Bela Vista, São Paulo, SP, 01308-050, Brazil.
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19
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The quality of care of the dying in hospital-next-of-kin perspectives. Support Care Cancer 2020; 28:4527-4537. [PMID: 32388617 PMCID: PMC7378108 DOI: 10.1007/s00520-020-05465-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/13/2020] [Indexed: 11/07/2022]
Abstract
Purpose Providing high-quality care for the dying is essential in palliative care. Quality of care can be checked, compared, and improved by assessing responses from bereaved next-of-kin. The objectives of this study are to examine quality of care in the last 2 days of life of hospitalized patients considering specific aspects of their place of care. Methods The “Care of the Dying Evaluation” (CODE™) questionnaire, validated in German in 2018 (CODE-GER), examines quality of care for the patient and support of next-of-kin, allocating values between 0 (low quality) and 4 (high quality). The total score (0–104) is divided into subscales which indicate support/time given by doctors/nurses, spiritual/emotional support, information/decision-making, environment, information about the dying process, symptoms, and support at the actual time of death/afterwards. Next-of-kin of patients with an expected death in specialized palliative care units and other wards in two university hospitals between April 2016 and March 2017 were included. Results Most of the 237 analyzed CODE-GER questionnaires were completed by the patient’s spouse (42.6%) or children (40.5%) and 64.1% were female. Patients stayed in hospital for an average of 13.7 days (3–276; SD 21.1). Half of the patients died in a specialized palliative care unit (50.6%). The CODE-GER total score was 85.7 (SD 14.17; 25–104). Subscales were rated significantly better for palliative care units than for other wards. Unsatisfying outcomes were reported in both groups in the subscales for information/decision-making and information about the dying process. Conclusion The overall quality of care for the dying was rated to be good. Improvements of information about the dying process and decision-making are needed. Trial registration DRKS00013916 Electronic supplementary material The online version of this article (10.1007/s00520-020-05465-2) contains supplementary material, which is available to authorized users.
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20
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Loh KWJ, Ng T, Choo SP, Saw HM, Mahendran R, Tan C, Chang GCY, Ong YJ, Yee ACP, Chan A, Soo KC. Cancer Supportive and Survivorship Care in Singapore: Current Challenges and Future Outlook. J Glob Oncol 2019; 4:1-8. [PMID: 30241247 PMCID: PMC6223422 DOI: 10.1200/jgo.17.00117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Despite being a relatively young nation, Singapore has established itself as a leading multifaceted medical hub, both regionally and globally. Although Singapore continues to pursue excellence in oncology care, cancer supportive care and survivorship care remain in the infancy stage. In an effort to advance this important aspect of oncology care in Singapore, the first cancer supportive and survivorship care forum was held in December 2016, involving 74 oncology practitioners. The primary goals of this forum were to raise awareness of the importance of cancer supportive and survivorship care and to provide a platform for oncology practitioners of diverse backgrounds to converge and address the challenges associated with the delivery of cancer supportive and survivorship care in Singapore. Key challenges identified during this forum included, but were not limited to, care fragmentation in an oncologist-centric model of care, poor integration of allied health and rehabilitation services, passive engagement of community partners, lack of specialized skill sets and knowledge in supportive and survivorship care, and patient-related barriers such as poor health literacy. The survivorship care model commonly used in Singapore places an imbalanced emphasis on surveillance for cancer recurrence and second primary cancers, with little attention given to the supportive and survivorship needs of the survivors. In summary, these challenges set the stage for the development and use of a more survivor-centric model, one that focuses not only on cancer surveillance, but also on the broad and unique physical and psychosocial needs of survivors of cancer in Singapore.
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Affiliation(s)
- Kiley Wei-Jen Loh
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Terence Ng
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Su Pin Choo
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Hay Mar Saw
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Rathi Mahendran
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Celia Tan
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Gail Chia Yang Chang
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Yew Jin Ong
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Alethea Chung Pheng Yee
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Alexandre Chan
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
| | - Khee Chee Soo
- Wei-Jen Kiley Loh, Terence Ng, Su Pin Choo, Alethea Chung Pheng Yee, Alexandre Chan, and Khee Chee Soo, National Cancer Centre Singapore; Hay Mar Saw, Singapore General Hospital; Rathi Mahendran, National University Hospital; Celia Tan, Allied Health, Singhealth Services; Gail Chia Yang Chang, KK Women's and Children's Hospital; Yew Jin Ong, Singapore Cancer Society; and Alexandre Chan, National University of Singapore (NUS) and Duke-NUS Graduate Medical School, Singapore
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21
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Lennaerts H, Steppe M, Munneke M, Meinders MJ, van der Steen JT, Van den Brand M, van Amelsvoort D, Vissers K, Bloem BR, Groot M. Palliative care for persons with Parkinson's disease: a qualitative study on the experiences of health care professionals. BMC Palliat Care 2019; 18:53. [PMID: 31288821 PMCID: PMC6617627 DOI: 10.1186/s12904-019-0441-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/01/2019] [Indexed: 11/11/2022] Open
Abstract
Background Parkinson’s disease (PD) is a chronic and neurodegenerative disease associated with a wide variety of symptoms. The risk of complications increases with progression of the disease. These complications have a tremendous impact on the quality of life of people with PD. The aim of this study was to examine health care professionals’ experiences of potential barriers and facilitators in providing palliative care for people with PD in the Netherlands. Methods This was a qualitative descriptive study. The data were collected from 10 individual in-depth interviews and three focus groups (n = 29) with health care professionals. Health care professionals were selected based on a positive answer to the question: “In the past 2 years, did you treat or support a person with PD who subsequently died?” The data were analyzed by thematic text analysis. Results Health care professionals supported the development of a palliative care system for PD but needed to better understand the essence of palliative care. In daily practice, they struggled to identify persons’ needs due to interfering PD-specific symptoms such as cognitive decline and communication deficits. Timely addressing the personal preferences for providing palliative care was identified as an important facilitator. Health care professionals acknowledged being aware of their lack of knowledge and of their little competence in managing complex PD. Findings indicate a perceived lack of care continuity, fragmentation of services, time pressure and information discontinuity. Conclusions Health care professionals experienced several facilitators and barriers to the provision of palliative care to people with PD. There is a need to improve the knowledge on complex PD and the continuity of information, as well as optimize coordination and deliver care based on a persons’ preferences. Additional training can help to become more knowledgeable and confident. Electronic supplementary material The online version of this article (10.1186/s12904-019-0441-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Herma Lennaerts
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands.
| | - Maxime Steppe
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Van den Brand
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Reinier Postlaan 4, 6500, Nijmegen, AB, The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
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22
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Becqué YN, Rietjens JAC, van Driel AG, van der Heide A, Witkamp E. Nursing interventions to support family caregivers in end-of-life care at home: A systematic narrative review. Int J Nurs Stud 2019; 97:28-39. [PMID: 31132687 DOI: 10.1016/j.ijnurstu.2019.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Family caregivers are crucial in end-of-life care. However, family caregiving may involve a significant burden with various negative health consequences. Although nurses are in a unique position to support family caregivers at home, little is known about which nursing interventions are effective in this context. Therefore, this study aims to provide insight into nursing interventions currently available to support family caregivers in end-of-life care at home and to describe their effects. METHODS A systematic search was conducted in Embase, Medline Ovid, Web of Science, Cochrane Central, CINAHL and Google Scholar. This review included quantitative studies published from January 2003 until December 2018 reporting on nursing interventions to support adult family caregivers in end-of-life care at home. Data were extracted on intervention modalities, intervention components, and family caregivers' outcomes. Methodological quality of the studies was assessed with the Cochrane Risk of Bias Tool. RESULTS Out of 1531 titles, nine publications were included that reported on eight studies/eight interventions. Of the eight studies, three were randomised controlled trials, one a pilot randomised trial, one a non-randomised trial, and three were single-group prospective studies. Four intervention components were identified: psychoeducation, needs assessment, practical support with caregiving, and peer support. Psychoeducation was the most commonly occurring component. Nursing interventions had a positive effect on the preparedness, competence, rewards, and burden of family caregivers. Multicomponent interventions were the most effective with, potentially, the components 'needs assessment' and 'psychoeducation' being the most effective. CONCLUSIONS Although only eight studies are available on nursing interventions to support family caregivers in end-of-life care at home, they show that interventions can have a positive effect on family caregivers' outcomes. Multicomponent interventions proved to be the most successful, implying that nurses should combine different components when supporting family caregivers.
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, the Netherlands; Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - Judith A C Rietjens
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Anne Geert van Driel
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, the Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, the Netherlands; Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands
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23
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Demiris G, Oliver DRP, Courtney KL, Porock D. Use of Technology as a Support Mechanism for Caregivers of Hospice Patients. J Palliat Care 2019. [DOI: 10.1177/082585970502100411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- George Demiris
- School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | | | - Karen L Courtney
- School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Davina Porock
- School of Nursing, University of Nottingham, Nottingham, UK
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24
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Duggleby W, Wright K, Williams A, Degner L, Cammer A, Holtslander L. Developing a Living with Hope Program for Caregivers of Family Members with Advanced Cancer. J Palliat Care 2019. [DOI: 10.1177/082585970702300104] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A theory-based intervention, the Living with Hope Program (LWHP), was designed to foster hope in caregivers of family members with advanced cancer. The LWHP was developed from qualitative data and using Harding and Higginson's recommendations for family caregiver interventions as a guide. The LHWP is: a) focused specifically on the caregivers themselves, b) theory based, c) feasible, d) acceptable, and e) pilot tested. The program consists of a hope video and a hope activity titled Stories of the Present. A mixed-method, concurrent triangulation, pre- and post-test design was used to pilot test the LWHP. The results of the pilot test suggest the LWHP is easy to use, flexible, and feasible, and shows promise in increasing hope and quality of life scores in family caregivers.
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Affiliation(s)
- Wendy Duggleby
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Karen Wright
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Allison Williams
- School of Geography and Geology, McMaster University, Hamilton, Ontario
| | - Lesley Degner
- Faculty of Nursing, Evidence-Based Nursing Practice, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Manitoba
| | - Allison Cammer
- Institute of Agricultural Rural and Environmental Health, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan
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25
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Hudson PL, Hayman-White K, Aranda S, Kristjanson LJ. Predicting Family Caregiver Psychosocial Functioning in Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970602200302] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Health professionals are expected to support family caregivers of patients requiring palliative care. However, there is a dearth of empirical evidence to help clinicians identify caregivers who might be at risk of poor psychosocial functioning. Purpose This secondary analysis of baseline data from a larger study sought to determine if it was possible to predict the psychosocial functioning of family caregivers who were supporting a relative with advanced incurable cancer. Method Data from 35 primary family caregivers obtained at the start of home-based palliative care services and five weeks later was used in the analysis. Instruments to measure caregiver preparedness, competence, mastery, social support, anxiety, and self-efficacy were used. Results Cluster and logistic analyses revealed that self-reported “anxiety” and “competence” subscale total scores at time of commencement of home-based palliative care services were associated with caregivers at risk of lower levels of psychosocial functioning five weeks later. Conclusions This study suggests that it may be possible to identify family caregivers who are at risk for poorer psychosocial functioning. However, replication in a larger sample is required before this screening approach can be recommended for clinical use.
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Affiliation(s)
- Peter L. Hudson
- Centre for Palliative Care, St. Vincent's Health and University of Australia, Melbourne
| | - Karla Hayman-White
- Centre for Psychiatric Nursing Research and Practice, School of Nursing, University of Melbourne
| | - Sanchia Aranda
- Peter MacCallum Cancer Centre and School of Nursing, University of Melbourne, Melbourne, Victoria
| | - Linda J. Kristjanson
- Office of Research and Development, Curtin University of Technology, Western Australia, Australia
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26
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Schaffler JL, Tremblay S, Laizner AM, Lambert S. Developing education materials for caregivers of culturally and linguistically diverse patients: Insights from a qualitative analysis of caregivers' needs, access and understanding of information. Health Expect 2019; 22:444-456. [PMID: 30767349 PMCID: PMC6543161 DOI: 10.1111/hex.12867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/28/2018] [Accepted: 12/13/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives To explore the information needs of caregivers of culturally and linguistically diverse (CALD) patients, and how they access and understand health information related to the management of their care person's chronic illness(es). Background Caregivers of CALD patients experience greater unmet needs compared to the general caregiver population. They experience many challenges in identifying resources and accessing formal supports to aid in self‐management behaviours. Methods Eleven caregivers were recruited from outpatient clinics in Québec, Canada. Consenting caregivers participated in one face‐to‐face or phone interview. A qualitative descriptive design and inductive content analysis were used to identify themes. Results Caregivers described a “village” approach to caregiving in which more than one individual was involved in patient care. The specific roles ascribed to caregivers defined their information needs. Caregivers described two categories of information needs: perceived and unperceived. Perceived information needs were explicit, and centred on the medical management of illnesses. Unperceived needs were unrecognized knowledge gaps that emerged during interviews and focused on self‐care. Conclusion Although caregivers' perceived needs are often met, their unperceived needs remain unmet. Health‐care providers should perform need assessments to identify caregivers' unperceived needs, with the aims of providing culturally competent care and ongoing support.
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Affiliation(s)
- Jamie L Schaffler
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Sarah Tremblay
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Andréa M Laizner
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada.,McGill University Health Centre, Montréal, Québec, Canada.,Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Sylvie Lambert
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada.,St. Mary's Research Centre, Montréal, Québec, Canada
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27
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Effects of a psychosocial intervention on the quality of life of primary caregivers of women with breast cancer. Eur J Oncol Nurs 2019; 38:85-91. [DOI: 10.1016/j.ejon.2018.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
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28
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Galatsch M, Prigerson HG, Schnepp W, Zu Sayn-Wittgenstein F, Li J. Caregiver exposure to critical events and distress in home-based palliative care in Germany a cross-sectional study using the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) scale. BMC Palliat Care 2019; 18:9. [PMID: 30678682 PMCID: PMC6346516 DOI: 10.1186/s12904-019-0395-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background Lay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient’s care. Yet, to our knowledge, no study to date has examined the family caregivers’ exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient’s critical health events and relate that to the caregiver’s own psychological distress to examine associations with general health within a home-based palliative care situation in Germany. Methods A cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data. Results The frequency of the caregiver’s exposure, or witness of, critical health events of the patient ranged from 95.2% “pain/discomfort” to 20.8% “family caregiver thought patient was dead”. The highest distress scores assessing fear and helpfulness were associated with “family caregiver felt patient had enough’” and “family caregiver thought patient was dead”. Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta = .408, p = .025) and total score (beta = .377, p = .007) with general health in family caregivers. Conclusions Family caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver’s degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.
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Affiliation(s)
- Michael Galatsch
- Research group "FamiLe - Family health in the life course", Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,Department of Nursing Science, Witten/Herdecke University, Witten, Germany.
| | - Holly G Prigerson
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, USA.,Cornell Center for Research an End-Of-Life Care, Weill Cornell Medicine, New York, USA
| | - Wilfried Schnepp
- Research group "FamiLe - Family health in the life course", Department of Nursing Science, Witten/Herdecke University, Witten, Germany.,Department of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Friederike Zu Sayn-Wittgenstein
- Research group "FamiLe - Family health in the life course", Department of Nursing Science, Witten/Herdecke University, Witten, Germany.,Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Jian Li
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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29
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Preisler M, Rohrmoser A, Goerling U, Kendel F, Bär K, Riemer M, Heuse S, Letsch A. Early palliative care for those who care: A qualitative exploration of cancer caregivers’ information needs during hospital stays. Eur J Cancer Care (Engl) 2019; 28:e12990. [DOI: 10.1111/ecc.12990] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/08/2018] [Accepted: 12/16/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Martina Preisler
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Amy Rohrmoser
- Medical Department, Charité Comprehensive Cancer Center; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Ute Goerling
- Medical Department, Charité Comprehensive Cancer Center; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Friederike Kendel
- Institute of Medical Psychology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Konrad Bär
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
| | - Manuel Riemer
- Wilfrid Laurier University; Department of Psychology; Waterloo Ontario Canada
| | - Silke Heuse
- Institute of Medical Psychology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Anne Letsch
- Medical Department, Division of Hematology and Oncology; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Berlin Germany
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30
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Gorawara-Bhat R, Graupner J, Molony J, Thompson K. Informal Caregiving in a Medically Underserved Community: Challenges, Construction of Meaning, and the Caregiver-Recipient Dyad. SAGE Open Nurs 2019; 5:2377960819844670. [PMID: 33415239 PMCID: PMC7774370 DOI: 10.1177/2377960819844670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/13/2019] [Accepted: 03/23/2019] [Indexed: 11/15/2022] Open
Abstract
Little is known about informal caregivers' challenges in medically underserved communities. This qualitative study explores their perceptions/experiences of caregiving in a medically underserved community in Midwest United States. Two focus groups (n = 12) were conducted and themes were extracted and analyzed. Theme 1 included perceived barriers/unmet needs; most prevalent of which were lack of informational resources and support groups. A second unsolicited and unanticipated theme highlighted how caregivers constructed meaning through reappraising challenges to create enriching experiences for themselves, reinforcing their evolving dyadic relationship with care-recipient. Challenging and enriching aspects of caregiving coexisted and were rooted in caregiver-care-recipient dyad. Caregivers used meaning-making as a coping strategy for challenges. Prior research corroborates caregivers' challenges and meaning-making; this study contributes by delineating how both become interrelated. Policy makers can (a) alleviate challenges by increasing informational resources and support groups and (b) provide training to optimize caregivers' meaning-making, thus enhancing their positive experiences.
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Affiliation(s)
| | | | - Jason Molony
- Department of Medicine, The
University of Chicago, IL, USA
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31
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Kentish-Barnes N, Chevret S, Azoulay E. Guiding intensive care physicians' communication and behavior towards bereaved relatives: study protocol for a cluster randomized controlled trial (COSMIC-EOL). Trials 2018; 19:698. [PMID: 30577862 PMCID: PMC6303988 DOI: 10.1186/s13063-018-3084-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022] Open
Abstract
Background Providing appropriate support and care for end-of-life patients and their relatives is a major concern and a daily responsibility for intensivists. Bereaved relatives of non-surviving patients in intensive care units (ICUs) often suffer from prolonged grief, posttraumatic stress disorder, anxiety, and depression. A physician-driven intervention, consisting of three meetings with the family, might reduce the post-ICU burden of bereaved family members 6 month after death. The patient’s nurse is actively involved at each step. We hypothesize that this strategy will improve communication in the end-of-life setting and thus, should reduce the post-ICU burden for family members, specifically the development of prolonged grief 6 months after the death. Methods/design The COSMIC-EOL trial is a prospective, multicenter, cluster randomized controlled trial in which centers are allocated to two parallel arms: (1) intervention centers where relatives benefit from three-step physician-driven support during the dying and death process and (2) control centers where, during the dying and death process, relatives receive the standard of care practice. Each of the 36 participating centers will include 25 relatives of patients with a length of stay ≥2 days. Participating relatives will be followed up by phone at 1, 3, and 6 months after the patient’s death to complete questionnaires permitting evaluation of their post-ICU burden. The main outcome is prolonged grief measured 6 months after the death using the PG-13. Other outcomes include evaluation of quality of dying, quality of communication, anxiety, depression, and post-traumatic stress. The estimated duration of the study is 36 months. Discussion The results of the trial will provide information about the effectiveness of physician-driven support for relatives of patients dying in an ICU. The study is expected to demonstrate a decrease in the ICU burden for bereaved relatives who benefitted from this intervention. Trial Registration ClinicalTrials.gov, NCT02955992. Registered on November 3rd 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-3084-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy Kentish-Barnes
- AP-HP, Saint Louis University Hospital, Medical Intensive Care Unit, Famiréa Group, 1 avenue Claude Vellefaux, Paris, France.
| | - Sylvie Chevret
- ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Elie Azoulay
- AP-HP, Saint Louis University Hospital, Medical Intensive Care Unit, Famiréa Group, 1 avenue Claude Vellefaux, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
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32
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Ward-Griffin C, McWilliam C, Oudshoorn A. Negotiating Relational Practice Patterns in Palliative Home Care. J Palliat Care 2018. [DOI: 10.1177/082585971202800206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing palliative care in the home presents a variety of challenges for nurses and other care providers. As part of a focused ethnographic study examining client/caregiver/care-provider relationships within the socio-cultural context of home-based palliative care, this paper describes the provision of palliative care to Canadian seniors with advanced cancer from the perspective of nurses. Data were collected through in-depth interviews (n=19) with three palliative care nurses and participant observations in four households over a six-to-eight-month period. Home-based palliative care nursing was depicted in this study as a dialectical experience, revealing three relational practice patterns: making time-forfeiting time, connecting-withdrawing, and enabling-disabling. Nurses attempted to negotiate the tensions between these opposing approaches to palliative care. Study findings suggest that the socio-cultural context of palliative care is not conducive to high-quality palliative care and provide several insights related to future directions for practice, policy, and research.
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Affiliation(s)
- Catherine Ward-Griffin
- C Ward-Griffin (corresponding author): Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada N6A 5C1
| | - Carol McWilliam
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Abram Oudshoorn
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
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33
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Magill L. Caregiver Empowerment and Music Therapy: Through the Eyes of Bereaved Caregivers of Advanced Cancer Patients. J Palliat Care 2018. [DOI: 10.1177/082585970902500114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lucanne Magill
- School of Music, University of Windsor, Windsor, Ontario, Canada
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34
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Parmar J, Torti J, Brémault-Phillips S, Charles L, Chan K, Tian PGJ. Supporting Family Caregivers of Seniors Within Acute and Continuing Care Systems. Can Geriatr J 2018; 21:292-296. [PMID: 30595779 PMCID: PMC6281380 DOI: 10.5770/cgj.21.317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Family caregivers who provide care to seniors at no cost to the healthcare system are an integral part of the healthcare system. Caregiving, however, can cause significant emotional, physical and financial burden. We held a one-day symposium on how to best involve and support family caregivers in the healthcare system. The symposium brought together caregivers, healthcare providers, administrators and policy-makers to identify needs and make recommendations to address these issues. METHODS Participants engaged in conversation circles which were audio-recorded and transcribed. Data were qualitatively analyzed alongside written notes provided by participants. RESULTS Symposium participants identified a lack of both orientation and education for healthcare providers about family caregivers and standardized processes for assessing caregiver burden. They highlighted a need to ensure that the family experience is captured and included as an essential component of care, foster a culture of collaboration, expand the notion of the healthcare team to include family caregivers, provide more integrated palliative care, and enhance policies and programs to acknowledge family caregivers. CONCLUSION There is a need to recognize the essential role of family caregivers in seniors' health and well-being, and to take on a more comprehensive approach to patient care.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Covenant Health-Network of Excellence in Seniors’ Health and Wellness, Grey Nuns Community Hospital, Edmonton, AB, Canada
| | - Jacqueline Torti
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Lesley Charles
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karenn Chan
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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35
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Canzona MR, Love D, Barrett R, Henley J, Bridges S, Koontz A, Nelson S, Daya S. “Operating in the dark”: Nurses’ attempts to help patients and families manage the transition from oncology to comfort care. J Clin Nurs 2018; 27:4158-4167. [DOI: 10.1111/jocn.14603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/24/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Mollie Rose Canzona
- Department of Communication; Wake Forest University; Winston-Salem North Carolina
- Department of Social Sciences & Health Policy; Wake Forest University School of Medicine; Winston-Salem North Carolina
| | | | - Rolland Barrett
- Gynecologic Oncology; Forsyth Medical Center; Novant Health; Winston-Salem North Carolina
| | | | | | | | | | - Serena Daya
- Department of Communication; University of Kentucky; Lexington UK
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36
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Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers. Ann Behav Med 2018; 51:519-531. [PMID: 28097515 DOI: 10.1007/s12160-017-9875-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Individuals with advanced, incurable cancer often experience high physical and psychological symptom burden. Family and friend caregivers are at risk for emotional distress. PURPOSE The aim of the study is to investigate the interrelationship of distress in patient-caregiver dyads at the time of newly diagnosed incurable cancer. METHODS From May 2011 to July 2015, within 8 weeks of diagnosis of advanced lung or noncolorectal gastrointestinal cancer, 350 patients and 275 family caregivers were enrolled in a randomized controlled trial of early palliative care. Actor-partner interdependence modeling was used to examine relationships between dyad's self-reported anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale at baseline. RESULTS Comparing patients with caregivers, patients reported more depressive symptoms (M diff = .84; t[274] = 3.17, p = .002, d = .22) and caregivers reported more anxiety symptoms (M diff =1.62, t[274] = 4.91, p < .001, d = .39). Dyads' anxiety symptoms were positively associated, as were depressive symptoms (rs = .21, ps ≤ .001). Actor-partner interdependence modeling showed that patients' anxiety symptoms were positively associated with their own depressive symptoms, with an equal effect for caregivers (actor effect βs = 0.52, ps < .001). Patients' own anxiety was concurrently positively associated with their caregivers' depressive symptoms, with an equal effect for caregivers to patients (partner effect βs=0.08, ps=.008). CONCLUSIONS In the context of newly diagnosed incurable cancer, caregivers experience more pronounced anxiety, while patients report greater depressive symptoms. Findings indicate that anxiety and depressive symptoms are interrelated among dyads facing newly diagnosed incurable disease. Results emphasize the importance of addressing distress in both patients and caregivers. Future research should discern when dyadic versus individual psychosocial interventions would be optimal. TRIAL REGISTRATION NUMBER The trial was registered with the ClinicalTrials.gov database (NCT02349412) https://clinicaltrials.gov/ct2/show/NCT02349412 .
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Phongtankuel V, Adelman RD, Reid MC. Mobile health technology and home hospice care: promise and pitfalls. PROGRESS IN PALLIATIVE CARE 2018; 26:137-141. [PMID: 30505077 DOI: 10.1080/09699260.2018.1467109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
With the increasing use of mobile devices (e.g., smart phones, tablets) in our everyday lives, people have the ability to communicate and share information faster than ever before. This has led to the development of promising applications aimed at improving health and healthcare delivery for those with limited access. Hospice care, which is commonly provided at home, may particularly benefit from the use of this technology platform. This commentary outlines several potential benefits and pitfalls of incorporating mobile health (mHealth) applications into existing home hospice care while highlighting some of the relevant telemedicine work being done in the palliative and End-of-Life care fields.
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Affiliation(s)
- Veerawat Phongtankuel
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ronald D Adelman
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - M C Reid
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
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38
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Poulos RG, Harkin D, Poulos CJ, Cole A, MacLeod R. Can specially trained community care workers effectively support patients and their families in the home setting at the end of life? HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e270-e279. [PMID: 29164739 DOI: 10.1111/hsc.12515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Surveys indicate that many Australians would prefer to die at home, but relatively few do. Recognising that patients and their families may not have the support they need to enable end-of-life care at home, a consortium of care providers developed, and received funding to trial, the Palliative Care Home Support Program (PCHSP) across seven health districts in New South Wales, Australia. The programme aimed to supplement end-of-life care in the home provided by existing multidisciplinary community palliative care teams, with specialist supportive community care workers (CCWs). An evaluation of the service was undertaken, focussing on the self-reported impact of the service on family carers (FCs), with triangulation of findings from community palliative care teams and CCWs. Service evaluation data were obtained through postal surveys and/or qualitative interviews with FCs, community palliative care teams and CCWs. FCs also reported the experience of their loved one based on 10 items drawn from the Quality of Death and Dying Questionnaire (QODD). Thematic analysis of surveys and interviews found that the support provided by CCWs was valued by FCs for: enabling choice (i.e. to realise end-of-life care in the home); providing practical assistance ("hands-on"); and for emotional support and reassurance. This was corroborated by community palliative care teams and CCWs. Responses by FCs on the QODD items indicated that in the last week of life, effective control of symptoms was occurring and quality of life was being maintained. This study suggests that satisfactory outcomes for patients and their families who wish to have end-of-life care in the home can be enabled with the additional support of specially trained CCWs. A notable benefit of the PCHSP model, which provided specific palliative care vocational training to an existing community care workforce, was a relatively rapid increase in the palliative care workforce across the state.
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Affiliation(s)
- Roslyn G Poulos
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | | | - Christopher J Poulos
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
- HammondCare, Sydney, NSW, Australia
| | - Andrew Cole
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
- HammondCare, Sydney, NSW, Australia
| | - Rod MacLeod
- HammondCare, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
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39
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Laryionava K, Pfeil TA, Dietrich M, Reiter-Theil S, Hiddemann W, Winkler EC. The second patient? Family members of cancer patients and their role in end-of-life decision making. BMC Palliat Care 2018; 17:29. [PMID: 29454337 PMCID: PMC5816525 DOI: 10.1186/s12904-018-0288-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family members are important companions of severely ill patients with cancer. However, studies about the desirability and difficulties of integrating relatives in the decision-making process are rare in oncology. This qualitative study explores the family role in decisions to limit treatment near the end of life from the professionals' point of view. METHODS Qualitative in-depth interviews were conducted with oncologists (n = 12) and nurses (n = 6) working at the Department of Hematology/Oncology at the University Hospital in Munich, Germany. The data were analyzed using a descriptive qualitative methodology and discussed from a medical ethics perspective. RESULTS Four major themes played a central role in the perception of the medical staff in regard to family members. (1) Family impact on patients' treatment preferences. (2) Strong family wish for further treatment. (3) Emotional distress of the family related to the involvement in end-of-life decision-making. (4) Importance of knowing family structures. CONCLUSIONS The important role of the family members in patients' disease process is recognized by oncologists and oncology nurses. However, this does not seem to lead to an early involvement of the family members. Developing and establishing a systematic assessment of family members' needs and wishes in order to provide a specific-tailored support should become a priority for interdisciplinary clinical research in the near future.
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Affiliation(s)
- Katsiaryna Laryionava
- National Center for Tumor Diseases, Department of Medical Oncology, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Timo A Pfeil
- Department of Internal Medicine III (Haematology and Oncology), University Hospital Grosshadern, Munich, Germany
| | - Mareike Dietrich
- National Center for Tumor Diseases, Department of Medical Oncology, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Stella Reiter-Theil
- Department Clinical Ethics, Psychiatric Hospitals of the University Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Wolfgang Hiddemann
- Department of Internal Medicine III (Haematology and Oncology), University Hospital Grosshadern, Munich, Germany
| | - Eva C Winkler
- National Center for Tumor Diseases, Department of Medical Oncology, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
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Mroz EL, Poulin MJ, Grant PC, Depner RM, Breier J, Byrwa DJ, Wright ST. Caregiver Self-Esteem as a Predictor of Patient Relationship Satisfaction: A Longitudinal Study. J Palliat Med 2017; 21:376-379. [PMID: 29068755 DOI: 10.1089/jpm.2017.0231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Longitudinal assessment of patient-caregiver relationships will determine whether caregiver self-esteem determines patient relationship satisfaction at end of life. BACKGROUND Research on close relationships and caregiving supports the idea that informal caregivers' self-esteem may influence their relationships with their terminally ill loved ones. However, this connection has not yet been investigated longitudinally, nor has it been applied specifically to care recipients' relationship satisfaction. METHODS A sample of 24 caregivers and 24 patients in a hospice home care program were recruited. Multiple patient and caregiver interviews were used to conduct a longitudinal study to measure fluctuations in patient health, changes in patient and caregiver relationship satisfaction, and self-esteem over a three-month period. RESULTS An interaction between caregiver self-esteem and patient relationship satisfaction demonstrated the role that self-esteem plays between caregivers and patients enrolled in hospice care. Specifically, for patients with caregivers with low self-esteem, patient relationship satisfaction significantly decreased as the patient's physical health decreased, whereas for patients whose caregivers had high self-esteem, patient relationship satisfaction marginally increased during poorer physical health. DISCUSSION High self-esteem may allow caregivers to overcome feelings of burden and maladaptive anticipatory grief to remain satisfied in their relationship with the patient. Caregiver self-esteem appears to play a role in fostering patient relationship satisfaction at the end of life.
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Affiliation(s)
- Emily L Mroz
- 1 Department of Psychology, University of Florida , Gainesville, Florida
| | - Michael J Poulin
- 2 Department of Psychology, University at Buffalo , Buffalo, New York
| | - Pei C Grant
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - Rachel M Depner
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - Jennifer Breier
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - David J Byrwa
- 3 Department of Research, Palliative Care Buffalo, The Center for Hospice & Palliative Care , Buffalo, New York
| | - Scott T Wright
- 4 Department of Research, Palliative Care Buffalo , Buffalo, New York
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Pham Q, Cafazzo JA, Feifer A. Adoption, Acceptability, and Effectiveness of a Mobile Health App for Personalized Prostate Cancer Survivorship Care: Protocol for a Realist Case Study of the Ned App. JMIR Res Protoc 2017; 6:e197. [PMID: 29025699 PMCID: PMC5658643 DOI: 10.2196/resprot.8051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/30/2017] [Accepted: 09/13/2017] [Indexed: 12/29/2022] Open
Abstract
Background By 2030, prostate cancer will be the most commonly diagnosed cancer in North America. To mitigate this impending challenge, comprehensive support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care. mHealth apps have been lauded as a promising complement to current outpatient treatment and monitoring strategies, but have not yet been widely used to support prostate cancer survivorship needs. A realist evaluation is needed to examine the impact of such apps on the prostate cancer survivorship experience. Objective We seek to gain an understanding of how an mHealth app for prostate cancer survivorship care called Ned (No Evident Disease) is adopted and accepted by patients, caregivers, and clinicians. We also aim to determine the effect of Ned on health-related quality of life, satisfaction with cancer care, unmet needs, self-efficacy, and prostate cancer-related levels of anxiety. Methods The Ned case study is a 12-month mixed-methods embedded single-case study with a nested within-group pre-post comparison of health outcomes. We will give 400 patients, 200 caregivers, and 10 clinicians access to Ned. Participants will be asked to complete study assessments at baseline, 2 months, 6 months, and 12 months. We will conduct 30 semistructured qualitative interviews with patients (n=20) and their caregivers (n=10) poststudy to gain insight into their experience with the app. Results We recruited our first survivor in October 2017 and anticipate completing this study by May 2019. Conclusions This will, to our knowledge, be the first realist case study to evaluate an app for prostate cancer survivorship care. Prostate cancer survivors are set to increase in number and longevity, heightening the need for integrated survivorship solutions to provide them with optimal and durable outcomes. The knowledge gained from this study will comprehensively inform how and why Ned works, for whom, and in what circumstances. Understanding the impact of digital health interventions such as Ned on how survivors care for themselves is critical to realizing patient-centered care.
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Affiliation(s)
- Quynh Pham
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Feifer
- Carlo Fidani Regional Cancer Centre, Credit Valley Hospital, Trillium Health Partners, Mississauga, ON, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Preisler M, Heuse S, Riemer M, Kendel F, Letsch A. Early integration of palliative cancer care: patients’ and caregivers’ challenges, treatment preferences, and knowledge of illness and treatment throughout the cancer trajectory. Support Care Cancer 2017; 26:921-931. [DOI: 10.1007/s00520-017-3911-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/25/2017] [Indexed: 12/25/2022]
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Unmet Needs and Caregiver Burden Among Family Caregivers of Hospice Patients in South Korea. J Hosp Palliat Nurs 2017. [DOI: 10.1097/njh.0000000000000350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hendricks-Ferguson VL, Pradhan K, Shih CS, Gauvain KM, Kane JR, Liu J, Haase JE. Pilot Evaluation of a Palliative and End-of-Life Communication Intervention for Parents of Children With a Brain Tumor. J Pediatr Oncol Nurs 2017; 34:203-213. [PMID: 27920233 PMCID: PMC6711580 DOI: 10.1177/1043454216676836] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Providing timely palliative and end-of-life care (PC/EOL) information to parents of children with a serious illness is a national health care priority. The goals of this study were to determine feasibility, acceptability, and parent responses related to a PC/EOL communication intervention, titled "Communication Plan: Early through End of Life (COMPLETE)" to parents of children with a brain tumor. The study was a 2-site prospective, single-group pilot study targeting parents' stress and coping outcomes. The sample included 13 parents of 11 children (ie, 11 families). During the first 6 months postdiagnosis, we evaluated parent outcomes at 4 time points (baseline and 3 post-sessions). Our findings included significant decline in decision regret ( P = .0089); strong, significantly increased hope ( P ≤ .0001); and significantly decreased uncertainty ( P = .04). Over time, more than half of the parents (61.5%) preferred to receive information about their child's current condition and PC/EOL options. Our findings provide evidence to suggest that the COMPLETE intervention is feasible and acceptable and produces promising effects on 3 parent outcomes (ie, decision regret, hope, and uncertainty) in parents of children with a brain tumor. Further research is indicated to evaluate COMPLETE with a larger sample of parents of children with cancer and with a control group.
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Boersma I, Jones J, Coughlan C, Carter J, Bekelman D, Miyasaki J, Kutner J, Kluger B. Palliative Care and Parkinson's Disease: Caregiver Perspectives. J Palliat Med 2017; 20:930-938. [PMID: 28520498 DOI: 10.1089/jpm.2016.0325] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palliative care for Parkinson's disease (PD) is an emerging area of interest for clinicians, patients and families. Identifying the palliative care needs of caregivers is central to developing and implementing palliative services for families affected by PD. The objective of this paper was to elicit PD caregiver needs, salient concerns, and preferences for care using a palliative care framework. MATERIALS AND METHODS 11 PD caregivers and one non-overlapping focus group (n = 4) recruited from an academic medical center and community support groups participated in qualitative semi-structured interviews. Interviews and focus group discussion were digitally recorded, transcribed and entered into ATLAS.ti for coding and analysis. We used inductive qualitative data analysis techniques to interpret responses. RESULTS Caregivers desired access to emotional support and education regarding the course of PD, how to handle emergent situations (e.g. falls and psychosis) and medications. Participants discussed the immediate impact of motor and non-motor symptoms as well as concerns about the future, including: finances, living situation, and caretaking challenges in advanced disease. Caregivers commented on the impact of PD on their social life and communication issues between themselves and patient. All participants expressed interest and openness to multidisciplinary approaches for addressing these needs. CONCLUSIONS Caregivers of PD patients have considerable needs that may be met through a palliative care approach. Caregivers were receptive to the idea of multidisciplinary care in order to meet these needs. Future research efforts are needed to develop and test the clinical and cost effectiveness of palliative services for PD caregivers.
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Affiliation(s)
- Isabel Boersma
- 1 The Department of Neurology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Jacqueline Jones
- 2 The College of Nursing, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Christina Coughlan
- 1 The Department of Neurology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Julie Carter
- 3 The Department of Neurology, Oregon Health and Science University , Portland, Oregon
| | - David Bekelman
- 4 The Department of Internal Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado.,5 Departments of Medicine and Veterans Affairs Medical Center , Denver, Colorado
| | - Janis Miyasaki
- 6 The Division of Neurology, University of Alberta , Edmonton, Alberta
| | - Jean Kutner
- 4 The Department of Internal Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Benzi Kluger
- 1 The Department of Neurology, University of Colorado Anschutz Medical Campus , Aurora, Colorado
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Ullrich A, Ascherfeld L, Marx G, Bokemeyer C, Bergelt C, Oechsle K. Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliat Care 2017; 16:31. [PMID: 28486962 PMCID: PMC5424283 DOI: 10.1186/s12904-017-0206-z] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/28/2017] [Indexed: 11/15/2022] Open
Abstract
Background This pilot study aimed to investigate quality of life, psychological burden, unmet needs, and care satisfaction in family caregivers of advanced cancer patients (FCs) during specialized inpatient palliative care (SIPC) and to test feasibility and acceptance of the questionnaire survey. Methods During a period of 12 weeks, FCs were recruited consecutively within 72 h after the patient’s admission. They completed validated scales on several outcomes: quality of life (SF-8), distress (DT), anxiety (GAD-7), depression (PHQ-9), supportive needs (FIN), palliative care outcome (POS), and satisfaction with care (FAMCARE-2). We used non-parametric tests, t-tests and correlation analyses to address our research questions. Results FCs showed high study commitment: 74 FCs were asked to participate whereof 54 (73%) agreed and 51 (69%) returned the questionnaire. Except for “bodily pain”, FCs’ quality of life (SF-8) was impaired in all subscales. Most FCs (96%) reported clinically significant own distress (DT), with sadness, sorrows and exhaustion being the most distressing problems (80–83%). Moderate to severe anxiety (GAD-7) and depression (PHQ-9) were prevalent in 43% and 41% of FCs, respectively. FCs scored a mean number of 16.3 of 20 needs (FIN) as very or extremely important (SD 3.3), 20% of needs were unmet in >50% of FCs. The mean POS score assessed by FCs was 16.6 (SD 5.0) and satisfaction (FAMCARE-2) was high (73.4; SD 8.3). Conclusions This pilot study demonstrated feasibility of the questionnaire survey and showed relevant psychosocial burden and unmet needs in FCs during SIPC. However, FCs’ satisfaction with SIPC seemed to be high. A current multicenter study evaluates these findings longitudinally in a large cohort of FCs.
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Affiliation(s)
- Anneke Ullrich
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. .,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lilian Ascherfeld
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gabriella Marx
- Department of Palliative Medicine, University Medical Center Göttingen, Von-Siebold-Str. 3, 37075, Göttingen, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Spatuzzi R, Giulietti MV, Ricciuti M, Merico F, Meloni C, Fabbietti P, Ottaviani M, Violani C, Cormio C, Vespa A. Quality of life and burden in family caregivers of patients with advanced cancer in active treatment settings and hospice care: A comparative study. DEATH STUDIES 2017; 41:276-283. [PMID: 27982741 DOI: 10.1080/07481187.2016.1273277] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to evaluate caregiver burden and quality of life (QoL) in active treatment settings and hospice care for 76 family caregivers of advanced cancer patients, using the Medical Outcomes Study Short Form and the Caregiver Burden Inventory. Compared to the active group, the hospice group reported significantly lower QoL scores in mental component summary score and higher scores in general health subscale and in physical component summary score. Future research needs to further investigate the complexities of caregivers' needs, especially in the emotional and mental domains, and offer effective, clinically proven interventions.
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Affiliation(s)
| | - Maria Velia Giulietti
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | | | - Fabiana Merico
- c Palliative Care Center , "Casa di Betania" Hospice , Tricase , Lecce , Italy
| | - Cristina Meloni
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | - Paolo Fabbietti
- d Biostatistical Center , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | - Marica Ottaviani
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | | | - Claudia Cormio
- f Experimental Unit of Psycho-oncology , National Research Centre "Giovanni Paolo II," , Bari , Italy
| | - Anna Vespa
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
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Tarolli CG, Chesire AM, Biglan KM. Palliative Care in Huntington Disease: Personal Reflections and a Review of the Literature. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:454. [PMID: 28428907 PMCID: PMC5395679 DOI: 10.7916/d88057c7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/20/2017] [Indexed: 01/03/2023]
Abstract
Background Huntington disease is a fatal, autosomal dominant, neurodegenerative disorder manifest by the triad of a movement disorder, behavioral disturbances, and dementia. At present, no curative or disease modifying therapies exist for the condition and current treatments are symptomatic. Palliative care is an approach to care that focuses on symptom relief, patient and caregiver support, and end of life care. There is increasing evidence of the benefit of palliative care throughout the course of neurodegenerative conditions including Parkinson disease and amyotrophic lateral sclerosis. However, beyond its application at the end of life, little is known about the role of palliative care in Huntington disease. Methods In this article, we discuss what is known about palliative care in Huntington disease, specifically related to early disease burden, caregiver burnout, advance care planning, and end of life care. Results We provide a review of the current literature and discuss our own care practices. Discussion We conclude by discussing questions that remain unanswered and positing ideas for future work in the field.
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Affiliation(s)
| | - Amy M Chesire
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Kevin M Biglan
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Early Phase Clinical Development, Neurosciences, Eli Lilly and Company, Indianapolis, IN, USA
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Differential effects of patient symptom subtypes on informal hospice caregiver depression. Palliat Support Care 2017; 16:127-136. [PMID: 28137342 DOI: 10.1017/s1478951516001152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:Researchers sought to determine the extent to which burden related to patients' symptom subtypes could predict informal hospice caregiver depression, and to illustrate the differences between caregivers who experience suicidal ideation and those who do not. METHOD Informal caregivers recruited from a not-for-profit community-based hospice agency participated in a cross-sectional survey. Self-report questionnaires assessed caregiver burden associated with patient symptomatology (via a modified version of the Memorial Symptom Assessment Scale-Short Form) and caregiver depressive symptoms, including suicidal ideation (measured by the Patient Health Questionnaire-9). Multiple regressions evaluated the unique predictability of patients' symptom subtypes on caregiver depression. Exploratory analyses examined mean differences of study variables between participants who did and did not endorse suicidal ideation. RESULTS Caregiver burden related to patients' psychological symptoms accounted for significant variance in caregiver depression scores when controlling for burden related to physical symptoms. Among 229 caregivers (M age = 61.4 years), 12 reported suicidal ideation, where 6 of the 12 were male, despite male caregivers comprising less than 20% of the total sample. SIGNIFICANCE OF RESULTS Burden associated with patients' psychological symptoms uniquely contributed to caregiver depression, further highlighting the clinical utility and necessity for hospice providers to address the emotional needs of patients and their caregivers alike. Developing clinical procedures to identify and respond to such needs would not only behoove hospice agencies, but it would likely enhance the caregiving experience holistically, which might be particularly imperative for male caregivers.
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Almutairi KM, Alodhayani AA, Alonazi WB, Vinluan JM. Assessment of Health-Related Quality of Life Among Caregivers of Patients with Cancer Diagnosis: A Cross-Sectional Study in Saudi Arabia. JOURNAL OF RELIGION AND HEALTH 2017; 56:226-237. [PMID: 27236467 DOI: 10.1007/s10943-016-0261-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A descriptive cross-sectional survey was conducted over 5 months in two tertiary hospitals in Riyadh, Saudi Arabia. The 5-month period was from November 2014 to March 2015. The survey instrument used was a Short-Form Health Survey SF-36 (the RAND 36-item) questionnaire that measure QOL of the caregivers. Our study subjects included 289 randomly selected Saudi caregivers. Almost all the mean scores were increased (higher than 50) with the exception of levels of energy/fatigue. Role functioning/physical scored the highest (81.02 ± 35.33) followed by physical functioning (76.34 ± 29.83). Other domains of QOL scored (71.02 ± 35.33) for the role functioning/emotional; pain (71.15 ± 28.48), emotional well-being (60.58 ± 18.44); social functioning (58.39 ± 25.83), and general health (54.32 ± 17.08). In multivariate regression analysis, the model predicts that the contributions of age, gender, and the cancer type of patients were a statistically significant predictor with the QOL domains of caregivers. Cancer caregivers in Saudi Arabia caring for patients more than 1 year after diagnosis reported favorable QOL. Factors associated with QOL domains included age, gender of the caregivers, and the types of cancer patients. These findings are encouraging as a baseline for providing more information to future studies in QOL of caregivers.
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Affiliation(s)
- Khalid M Almutairi
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulaziz A Alodhayani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wadi B Alonazi
- College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Jason M Vinluan
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
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